14781-koppen

286 Chapter 14 Non-pharmacological and pharmacological treatment The non-pharmacological and pharmacological approach towards children with FC among responders is shown in Table 2. Most commonly employed non-pharmacological interventions included a bowel diary (70%), a toilet program (76%) and dietary advice (82%). Osmotic laxatives (88%), stimulant laxatives (77%) and enemas (72%) were the most commonly used pharmacological treatments. Case-based questions The case-based questions (see Supplemental file) resulted in a variety of approaches among the 28 responders (16 faculty, 11 fellows and 1 resident) who reported using both anorectal manometry and colonic manometry. For each case, responders were asked to choose their initial therapeutic option for a childwith intractable FC and specificmanometry findings. The first case was a child who had normal colonic and anorectal manometry. The second case had an absent rectoanal inhibitory reflex (RAIR) on anorectal manometry in the presence of normal rectal biopsy results and a normal colonic manometry. The third case had a high anal canal resting pressure on anorectal manometry and a normal colonic manometry. The fourth case described a child who had a normal anorectal manometry and an abnormal colonic manometry showing absence of high amplitude propagating contractions in the colon distal to the transverse colon. The answers to these case-based questions are shown in Table 3. There was a considerable variety in the answers to each question. In the first case, the majority (61%) chose ACE. In the second and third case, most responders preferred anal botulinum toxin injections (respectively 46% and 64%). In the fourth case, ACE was selected most often (43%), although this question was also left unanswered by a considerable amount of responders (32%).